Externally Powered Upper-Limb Prostheses
T h e earliest reference to external­
ly powered upper-limb prostheses
seems to be in connection with ex­
periments that took place in G e r ­
m a n y about 1 9 1 8 in which electro­
magnets were used to close the fin­
gers of an artificial hand ( 1 6 ) . T h e
next reported effort apparently is
the research and development pro­
gram proposed and carried out b y
Alderson (1) on electrically powered
arm
systems
during
1946-1952
As a result of the findings of the
U C L A study, and because only a
limited amount of m o n e y was avail­
able for w o r k in artificial limbs, the
A d v i s o r y C o m m i t t e e on Artificial
Limbs (later the C o m m i t t e e on P r o s ­
thetics Research and Development)
of the National A c a d e m y of Sci­
ences recommended that develop­
ment of actuators be delayed until
sufficient research could be carried
out concerning the control problem
so as to provide means for control
of the prosthesis without conscious
thought b y the wearer.
A project was initiated at U C L A
about 1 9 5 3 to explore various c o n ­
trol methods. A m o n g the various
studies conducted at U C L A was an
evaluation of the so-called Vaduz
hand (Fig. 2) (6), a design that orig­
inated in Lichtenstein which used
bulging of the residual muscles in
a forearm stump to provide control
of an electrically actuated artificial
hand. S o m e rather positive findings
were overshadowed by the p o o r
quality of the one unit that was
available at the time, and perhaps
b y the introduction b y Russia in
1 9 5 8 of a "thought c o n t r o l " electric
arm (12). T h e Russian device actual­
ly consisted of an electric hand con­
trolled by myoelectric signals from
the residual forearm agonists and
antagonists of a below-elbow ampu­
tee.
T h e "Thalidomide tragedy" (9)
in 1 9 5 8 - 1 9 6 2 prompted England and
C a n a d a to secure manufacturing
rights to the Russian design, but
fabrication and distribution
was
not successful in either country.
T h e "Thalidomide tragedy" also en­
couraged w o r k at the University of
Heidelberg in the development of
Fig. 1. An early model of the AldersonIBM Electric Arm.
with support from
International
Business M a c h i n e s , Inc. and the
Veterans Administration.
Initial results of the AldersonI B M project (Fig. 1) were quite im­
pressive with respect to operation,
but an extensive evaluation at
U C L A in 1 9 5 1 revealed that a dis­
proportionate a m o u n t of mental
effort b y the wearer was required
for use of the various systems ( 6 ) .
Fig. 2. The "Valduz" hand and control system.
4) were designed and fabricated up­
on the return of T o m o v i c to Y u g o ­
slavia. Results of evaluation were
also overshadowed by p o o r w o r k ­
manship and engineering, and w o r k
on this was abandoned about 1 9 6 8 .
McLaurin, while at Northwest­
ern University, designed the socalled Michigan feeding arm about
1 9 6 0 which used a linkage to c o o r ­
dinate motions about the elbow
and the wrist to m a k e it possible for
young bilateral children amputees
to feed themselves ( 7 ) . This device
met with considerable success in
the clinical setting, but never be­
came a commercial success.
Fig. 3. On the pneumatic above-elbow systems developed by Kiessting at the
American Institute for Prosthetic Research.
pneumatically powered
artificial
arm systems ( 1 3 ) , and an agreement
was obtained b y Kessler and Kiessling (11) for continuation of this
w o r k in the U . S . (Fig. 3 ) . T h i s p r o j ­
ect was carried out between 1 9 6 0
and 1 9 6 9 . Again the problem of
control was the primary reason for
discontinuing the w o r k .
Because of the Thalidomide trage­
dy, Sweden (10) also launched a
modest program in development of
externally
powered
upper-limb
prostheses about 1 9 6 0 . W o r k in
this area has been carried out con­
tinuously since, but with no c o m ­
mercially available devices result­
ing, as far as is k n o w n at this time.
T h e Russian design caused an
Austrian group, V i e n n a t o n e , and
the O t t o B o c k C o m p a n y in Ger­
m a n y to develop and market about
1962 similar devices. A few years
later Hannes Schmidl began fitting
externally powered artificial arms
on a relatively large scale at the
INAIL Center, Budrio, Italy and
continues to do so to the present
time ( 1 8 ) . Pneumatic models were
used initially, but all designs used
n o w are electric.
Simpson ( 2 0 ) , at the Princess
Margaret Rose Hospital, Edinburgh,
Scotland uses routinely pneumatic
prostheses for a group of "Thalido­
mide" children, but his design is
not widely available elsewhere.
In 1 9 6 0 while on Sabbatical study
at the University of Southern Cali­
fornia T o m o v i c from the Institute
Pupin, Belgrade, suggested the use
of electromechanical pressure sen­
sitive systems to aid in solution to
the control problem b y introducing
closed-loop feedback systems (14,
2 1 ) . A number of prototypes (Fig.
McLaurin continued w o r k in elec­
trical arms for children at the O n tario Crippled Childrens Centre,
T o r o n t o , between 1 9 6 3 and 1 9 7 5 .
Although he was able to persuade
the Variety Club to develop a facil­
ity for manufacturing, at cost, some
of the products of research as a
philanthropic endeavor, to date
only an electric elbow has been
made available, but because of the
low volume the cost is extremely
high in spite of subsidization.
In the late sixties a number of ef­
forts in the U . S . were directed to­
ward the development of electric
elbows. B y 1 9 6 9 three designs were
considered ready for clinical evalua­
tion, the " B o s t o n " elbow developed
b y M . I . T . and Liberty Mutual In­
surance C o . , the A M B R L elbow,
developed b y the A r m y Medical
Biomedical Research L a b o r a t o r y ,
Fig. 4. The "Belgrade" hand and control system.
Fig. 5. The self-contained and self-suspended below-elbow system using myo­
electric controls developed at Northwestern University.
and a design by R a n c h o Los A m ig o s
Hospital. T h e clinical evaluation
program was organized and c o o r ­
dinated b y C P R D in 1 9 6 9 - 7 0 ( 5 ) .
O f 2 0 subjects in the study only 3
elected to retain the electric device.
T w o of these subjects had physical
problems that made operation of
the b o d y powered prosthesis more
difficult than would have been the
case otherwise. Out of this experi­
ence came a revised set of design
criteria and objectives.
In addition to all of these efforts,
research and development programs
in externally powered artificial arms
have been carried out in the U . S .
at Temple University - M o s s R e ­
habilitation Hospital ( 2 2 ) , North­
western University (Fig. 5) (4),
Veterans Administration Prosthetic
Center, D u k e University, R a n c h o
Los A m i g o s Hospital, University of
California at Los Angeles, the Uni­
versity of C o l o r a d o , and Johns
Hopkins University (8, 1 7 ) .
Sweden, Great Britain, Italy,
G e r m a n y , Russia, and others have
continued to support research and
development in this field.
Yet today it is very difficult to
obtain an electric or pneumatic arm
in the United States, other than the
electrically operated hands that are
suitable for below-elbow patients.
W e will be pleased to hear the opin­
ions of readers of the N E W S L E T ­
T E R concerning the reasons for
this.
A . Bennett Wilson, j r .
March 16, 1978
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